MRI contrast accumulation in features of cerebral small vessel disease: blood-brain barrier dysfunction or elevated vascular density?

IF 6.2 1区医学 Q1 NEUROSCIENCES

Fluids and Barriers of the CNS Pub Date : 2025-07-16 DOI:10.1186/s12987-025-00675-4

Tomas Vikner, Anders Garpebring, Cecilia Björnfot, Jan Malm, Anders Eklund, Anders Wåhlin

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引用次数: 0

Abstract

Background: White matter lesions (WML) and dilated perivascular spaces (PVS) are features of small vessel disease (SVD), commonly observed in aging and dementia, with unknown pathophysiology. Human studies have documented contrast accumulation within and in proximity of SVD-lesions. However, whether such observations mainly reflect excessive blood-brain barrier (BBB) leakage, or altered microvascular density in the investigated regions, remains unclear.

Methods: To evaluate the roles of BBB leakage and vascular density in aging and SVD, dynamic contrast enhanced (DCE) MRI was used to estimate the permeability-surface area product (PS) and fractional plasma volume ([Formula: see text]) in normal-appearing brain tissue and in proximity of and within WML and PVS in a population-based cohort (N = 56; 34/22 m/f; age 64 to 84 years). Analysis of variance (ANOVA) was used to assess regional differences in PS and [Formula: see text] and analysis of covariance (ANCOVA) was used to assess regional differences in PS with [Formula: see text] and vascular risk as covariates.

Results: Pronounced increases in PS and [Formula: see text] were observed from normal-appearing white matter (NAWM) to WML peripheries to WMLs. Similar PS and [Formula: see text]increases were observed from basal ganglia (BG) to BG-PVS. Further, PS in NAWM and white matter (WM) PVS were found to increase with cortex-to-ventricular depth. However, ANCOVA models with [Formula: see text] as a covariate showed that variance in PS was mainly explained by v_p (η²=0.17 to η²=0.35; all p < 10^- 3), whereas the effect of region was only borderline-significant when comparing NAWM, WML peripheries and WML (p = 0.03) and non-significant for the other comparisons (p > 0.29).

Conclusions: Our findings support the notion that contrast leakage across the BBB accumulates within and in proximity of SVD-related lesions. However, high contrast accumulation may mainly reflect high vascularization, and to a lesser degree than previously recognized BBB dysfunction.

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MRI造影剂积累在脑小血管疾病特征中的作用：血脑屏障功能障碍还是血管密度升高？

背景：白质病变（WML）和血管周围间隙扩张（PVS）是小血管病变（SVD）的特征，常见于衰老和痴呆，病理生理机制未知。人类研究已经证明了svd病变内部和附近的造影剂积累。然而，这些观察结果是否主要反映了过度的血脑屏障（BBB）渗漏，或者是研究区域微血管密度的改变，目前尚不清楚。方法：为了评估血脑屏障泄漏和血管密度在衰老和SVD中的作用，采用动态对比增强（DCE） MRI评估正常脑组织以及WML和PVS附近和内部的通透性-表面积积（PS）和分数血浆体积（[公式：见文]）。34/22 m / f;64岁至84岁)。采用方差分析（ANOVA）评估PS和[公式：见文]的地区差异，采用协方差分析（ANCOVA）评估PS的地区差异，以[公式：见文]和血管风险为协变量。结果：从外观正常的白质（NAWM）到WML外周再到WML， PS和[公式：见文本]均明显增加。从基底神经节（BG）到BG- pv，也观察到类似的PS和[公式：见文]增加。此外，NAWM和白质（WM） PVS的PS随着皮质-心室深度的增加而增加。然而，以[Formula: see text]为协变量的ANCOVA模型显示，PS的方差主要由vp （η2=0.17 ~ η2=0.35）来解释；在比较NAWM、WML周边和WML时，区域的影响仅为临界显著（p = 0.03），而在其他比较中，区域的影响不显著（p = 0.29）。结论：我们的研究结果支持了这样一种观点，即造影剂在血脑屏障上的泄漏在svd相关病变内部和附近积聚。然而，高造影剂积累可能主要反映高血管化，其程度低于先前认识到的血脑屏障功能障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Fluids and Barriers of the CNS Neuroscience-Developmental Neuroscience

CiteScore

10.70

自引率

8.20%

发文量

审稿时长

14 weeks

期刊介绍： "Fluids and Barriers of the CNS" is a scholarly open access journal that specializes in the intricate world of the central nervous system's fluids and barriers, which are pivotal for the health and well-being of the human body. This journal is a peer-reviewed platform that welcomes research manuscripts exploring the full spectrum of CNS fluids and barriers, with a particular focus on their roles in both health and disease. At the heart of this journal's interest is the cerebrospinal fluid (CSF), a vital fluid that circulates within the brain and spinal cord, playing a multifaceted role in the normal functioning of the brain and in various neurological conditions. The journal delves into the composition, circulation, and absorption of CSF, as well as its relationship with the parenchymal interstitial fluid and the neurovascular unit at the blood-brain barrier (BBB).